Pharmacological treatment of chronic fatigue syndrome: focusing on the role of antidepressants

Abstract

Chronic fatigue syndrome (CFS) is characterized by chronic, medically unexplained fatigue associated with effort- and stress-intolerance, widespread pain, and impairment in sleep and concentration. Although this constellation of symptoms is highly prevalent in clinical practice, the pathophysiological mechanisms underlying CFS are poorly understood. Current evidence indicates similarities in symptomatology, and possibly etiology and pathogenesis, between CFS and depression. Additionally, there is significant overlap between CFS and the syndrome of fibromyalgia for which antidepressants have shown consistent efficacy. Data regarding antidepressant treatment of CFS is less copious and less uniformly positive, such that antidepressant use in CFS remains controversial. The current review aims to summarize available data related to antidepressants and other psychotropic agents in CFS to provide a platform for clinicians to make decisions in their treatment of this challenging syndrome. We identified relevant studies through a PubMed literature search with a combination of the following search terms: 'fatigue,' 'depression,' 'antidepressant,' 'etiology' (e.g., 'neurobiology,' 'neurotransmitter,' 'genetic'), 'diagnosis,' and 'treatment' (e.g., 'antidepressant' plus the specific name). In addition, studies were also identified via the reference sections of retrieved articles. The authors thoroughly reviewed major findings from the scanned literatures and eventually synthesized them, providing summary, interpretation, and future directions.

Psychiatric Aspects of Chronic Fatigue Syndrome and Fibromyalgia

“…However, medication should always be used in the context of self-care, and clinicians should be aware of polypharmacy and related iatrogenic effects and drug interactions as a possible problem in CFS/FM [57,58].…”

“…Nonetheless, future pharmacotherapy studies should not neglect other important aspects of CFS/FM, such as further unraveling common neurobiological underpinnings of chronic pain/fatigue, stress, and depression [14•, 43], including the search for specific psychopharmacologic agents [57,58].…”

Pharmacological interventions for somatoform disorders in adults

“…In contrast to psychological therapies, however, the mechanisms of action of pharmacotherapy in somatoform disorders are still partly unclear. Based on the findings of research on chronic pain syndromes such as neuropathic pain (Saarto 2007) and fibromyalgia (Häuser 2009;O'Malley 2000), or other syndromes of MUPS such as irritable bowel syndrome (IBS) (Ford 2009;Jackson 2000;Jackson 2006) or chronic fatigue syndrome (Pae 2009), antidepressants in particular have been used. Furthermore, findings from studies examining the effects of antidepressants on psychiatric comorbid conditions that are common in patients with somatoform symptoms (e.g., depression or anxiety disorders), also support the administration of antidepressant drugs in patients with somatoform disorders (Verdu 2008;Whitehead 2002).…”

Amisulpride vs. fluoxetine treatment of Chronic Fatigue Syndrome: A pilot study

“…Different pharmacological agents have been evaluated in CFS patients; to date, triciclycs antidepressants and selective serotonin reuptake inhibitors (SSRI) represent the more widely used drug classes, albeit with mixed results (Pae et al, 2009).…”

“…Amisulpride, a substituted benzamide, is an atypical antipsychotic (Green, 2002) that presents potential as an effective treatment in CFS (Green, 2002;Pae et al, 2009). At low doses, amisulpride (100 mg/die or less) preferentially blocks presynaptic dopamine autoreceptors that control dopamine synthesis and release; whereas, at higher doses, it presents postsynaptic dopamine D2-receptor antagonism (Green, 2002).…”